The nurse is caring for a woman with obesity who is 3 days postoperative total hip joint replacement. Which laboratory value is of greatest concern and should be reported to the health care provider (HCP) immediately?

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Infection is a major complication associated with joint replacement surgery. A client with obesity (body mass index ≥30 kg/m²) is at even greater risk for infection due to inadequate tissue oxygenation as the vascularity of adipose tissue is decreased. This client is also at increased risk for postoperative pneumonia because obesity can lead to impaired pulmonary function, sleep apnea, and obesity hypoventilation syndrome. Leukocytosis can indicate a wound infection or postoperative pneumonia. Therefore, the increased WBC count (>11,000 mm³ [11.0 ×10⁹/L]) is of greatest concern and should be reported to the HCP immediately (Option D). (Option A) The BUN is slightly above the normal limits (6-20 mg/dL [2.1-7.1 mmol/L]) and is not the greatest concern. (Option B) The glucose is elevated (normal, 70-110 mg/dL [3.9-6.1 mmol/L]). However, the recommended random glucose level for hospitalized clients is <180 mg/dL (10 mmol/L); the recommended level before meals is <140 mg/dL (7.8 mmol/L). Obesity is often associated with metabolic syndrome and insulin resistance, and the physiologic stress of surgery can contribute to hyperglycemia as well. Although the nurse will report the glucose level and continue to monitor it, the level is not the greatest concern. (Option C) Decreased hematocrit (normal adult female 35%-47% [0.35-0.47]), and hemoglobin levels (normal 11.7-15.5 g/dL [117-155 g/L]) are to be expected in a client who has undergone joint replacement due to blood loss during the surgery. The nurse will continue to monitor these, but the current levels are not the greatest concern. Educational objective: Infection is a major complication associated with joint replacement surgery, and clients with obesity are at even greater risk. The nurse should notify the HCP immediately of any signs of postoperative wound infection (eg, leukocytosis, fever, increased wound drainage, erythema, increased pain).

The Nurse Is Caring for a Woman with Obesity Who